Reducing the Financial Pain of Lower Back Pain
With workers’ compensation costs on a relentless march upwards, studies suggesting that growth in some areas could possibly be tempered are sure to spark some interest and help validate what we intuitively deduce as cost savings. A recent example is Outcomes of the Introduction of a Standardized Fitness-for-Duty Evaluation of Commercial Truck Drivers on the Incidence of Low Back Injuries and Workers’ Compensation Costs, published in the April 2014 edition of the Journal of Occupational and Environmental Medicine, and authored by Konstantin V. Berestnev, MD, MPH, Gary L. Moffitt, MD, Dan S. Vancil, PT and Judith McKenzie, MD, MPH. The study, which concludes that costs associated with lower back injuries in commercial truck drivers could be reduced if companies implement an additional post-hire fitness-for-duty evaluation prior to an employee’s job assignment, continues to validate the use of Functional Capacity Evaluations for these high at-risk employees.
So why the emphasis on the lower back — and on commercial truck drivers in particular? The study points out that visits to the doctor are commonly prompted by low back pain. Health care costs for back problems reportedly jumped an estimated 65% between 1997 and 2005 alone. Indeed, the study states that some 30-40% of workers’ compensation costs are expended in connection with back injury claims, a significant portion of the pie. As for commercial truck drivers (an estimated 5.7 million of the nation’s workers), theirs is a physically demanding job. For example, according to the study, about one third of all truck driver work incidents in 2006 involved injuries to the back, resulting in nearly two thirds of days-away-from-work cases — reportedly the highest rate among “major occupational groups.” Some companies have responded by using a “Functional Capacity Evaluation” to assess a worker’s post-hire fitness-for-duty, and to use this information in making appropriate job placement decisions. The question is whether such intervention can reduce lower back injury and the resultant workers’ compensation costs.
Risk Management Tip: "Employers should use every tool in the toolbox, and the functional capacity evaluation (FCE) is a tool that has been used in the workers' compensation field for many years,” says Rebecca Shafer, JD, President of Amaxx Risk Solutions and author of Your Ultimate Guide to Mastering Workers’ Comp Costs. “It's all about finding the right job fit. In a pre-employment/post hire setting, measuring an individual's actual physical ability is key to ensuring they can safely perform the job for which they are hired. This reduces injuries to the employee and those around them. Using an FCE as both a pre- and post- hire tool allows an employer to identify job duties consistent with the employee's capabilities, locate transitional duty positions and if an ADA accommodation is needed, the FCE assists in determining the specifics of the accommodation."
Standardized Fitness for Duty Evaluation Program
The study evaluated the effect of a fitness-for-duty program called “RoadReady Evaluation” on low back injuries and associated workers’ compensation costs at a “large nationwide trucking company” which first implemented this program in 2003. (It should be noted that one author of the study, Gary L. Moffitt MD is identified as a Medical Director of RoadReady, Inc. and another, Dan Vancil, PT as its President.) The “RoadReady Evaluation” is described as a standardized fitness-for-duty evaluation which adds a Functional Capacity Evaluation to the Department of Transportation (“DOT”) examination. The study notes that “[t]his RoadReady Evaluation is not used to diagnose specific lower back conditions nor is it a tool to deny applicants a position.”
The evaluation is quite comprehensive. It begins with a review of the truck driver applicant’s musculoskeletal medical history. This includes inquiries into previous neck and/or back problems, including those for which surgical intervention was necessary. It also explores whether the applicant was previously under any work restrictions. The next step in the process is the functional examination, during which the applicant is run through a battery of physical tests including the following identified by the study: (1) back posture/alignment; (2) joint flexibility; (3) upper and lower muscle strength; (4) joint/ligament “integrity”; (5) balance/coordination. Based on his or her findings, the physical therapist makes a recommendation to the DOT examiner, who in turn makes a final decision on the certification status of the driver. Once this process is completed, the applicant is tested once more, this time for the ability to complete job-specific tasks. All the data is stored electronically in a searchable RoadReady database. Certification of a driver cannot occur until all prerequisite steps have been completed.
Occupational Medicine Perspective: Leslie J. Hutchinson, MD, MPH, FACOEM, of HLM Consultants agrees that employers of commercial drivers can reduce their risk for workers’ compensation and general liability claims through medical evaluations such as fitness for duty examinations and functional capacity evaluations. Hutchinson explains that “a fitness for duty evaluation by a physician can identify conditions that may lead to increased risks of injuries in loading and unloading cargo or jacking up a trailer when parking.”
Study Methodology and Results
The researchers looked at the truck company data over an eight-year period – each of the four years before the implementation of the “RoadReady Evaluation” (1999-2002) and each of the four years following implementation (2003– 2006). Specifically, they looked at incidence of lower back injury and associated workers’ compensation costs and compared them with upper back injury and associated costs (the upper back is not specifically tested during the fitness-for-duty examination). They found that both incidence of lower back injury and associated workers’ compensation costs declined between 1999 and 2006. Incidence of lower back injury declined 54%, while associated workers’ compensation costs declined 45%.
On the surface, these numbers look promising. However, the question is whether the improvements on both incidence and costs can actually be attributed to implementation of the “RoadReady Evaluation.” As the study itself acknowledges, data from the Bureau of Labor Statistics indicates that incidence of lower back injury among transportation workers in general fell 55% during this same time period (1999- 2006). This 55% industry reduction tracks the 54% rate found in the study population. The study notes that “[t]he reduction rates seen in the RoadReady population may be due to temporal trends and not to the intervention.” As for costs, however, the study noted that workers’ compensation costs for the subject company rose during the pre-intervention years (1999-2002) and began decreasing in 2003, the year the “RoadReady Evaluation” was introduced. While national data is apparently not available, the study points out that the Arkansas Workers’ Compensation Commission biennial reports show an increase in medical expenditures during this same time period (2003 – 2006). The study concluded that “the RoadReady post-hire evaluation introduction was associated with a 45% reduction in workers’ compensation costs associated with low back injuries in this population.”
The takeaway from this study is this — while the incidence of lower back injury and associated costs for the company studied decreased in the time period following implementation of the “RoadReady Evaluation”, it may be difficult to quantify how much of the decrease in incidence is attributable to the intervention and how much was part of a broader trend. Given the prevalence of lower back injuries, and the ongoing costs associated with treatment, further analysis of this issue may be helpful.
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